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Successful Treatment of Pediatric Atopic Prurigo Nodularis with Dupilumab
Yuping Zhang1, Lizhu Liang1, Chen Li1
1Department of Dermatology, Zhongshan City People's Hospital, Zhongshan City, Guangdong Province, 528403, People's Republic of China.
Insights
Dupilumab effectively treated pediatric prurigo nodularis (PN) in an 11-year-old. The treatment significantly reduced itching and skin lesions, with no recurrence after six months, demonstrating its therapeutic potential.
Area of Science:
- Dermatology
- Immunology
- Pediatrics
Background:
- Pediatric prurigo nodularis (PN) is a chronic, intensely itchy skin condition.
- Refractory cases often lack effective treatment options, impacting quality of life.
- Atopic comorbidities like allergic rhinitis are common in pediatric PN.
Observation:
- An 11-year-old presented with severe, refractory PN and allergic rhinitis.
- Previous treatments, including JAK1 inhibitors, were ineffective.
- The patient reported high pruritus (PP-NRS 9/10), severe skin involvement (IGA 3/3), and impaired quality of life (CDLQI 12/30).
Findings:
- Dupilumab treatment led to rapid symptom improvement within two weeks.
- Significant reductions in pruritus (PP-NRS), disease severity (IGA), and quality of life (CDLQI) were observed.
- The patient achieved sustained remission for six months post-treatment.
Implications:
- Dupilumab offers a promising therapeutic option for pediatric patients with refractory PN.
- Targeting the IL-4/IL-13 pathway may be beneficial in managing severe atopic skin diseases.
- Further research is warranted to confirm efficacy and safety in larger pediatric cohorts.
Purpose:
This study aims to evaluate the efficacy and safety of Dupilumab in treating pediatric atopic prurigo nodularis (PN).
Patient And Methods:
We present a case of an 11-year-old child with refractory prurigo nodularis for 9 months, accompanied by concurrent allergic rhinitis for 2 years. Conventional therapies and Janus kinase 1 (JAK1) inhibitors had not provided satisfactory results. At presentation, the child presented with a Peak Pruritus Numerical Rating Scale (PP-NRS) score of 9 on a scale of 10, the Investigator's Global Assessment (IGA) score of 3 out of 3, and the Children's Dermatology Life Quality Index (CDLQI) score of 12 out of 30.Dupilumab was administered subcutaneously, starting with an initial dose of 600 mg, followed by 300 mg every three weeks for four months. Subsequently, the injection interval was extended to once every four weeks for an additional two months.
Results:
Two weeks after initiating dupilumab treatment, the patient showed initial symptom relief, as evidenced by a reduction in PP-NRS, IGA, and CDLQI scores to 7, 2, and 6, respectively. By the fourth week, the patient experienced significant improvement in pruritus and skin lesions. Specifically, the PP-NRS, IGA, and CDLQI scores decreased by 7 points, 2 points, and 10 points, respectively. The patient discontinued medication after six months of treatment, and no recurrence was observed during the subsequent six-month follow-up period.
Conclusion:
Dupilumab appears to be an effective therapy for refractory prurigo nodularis with atopic features.
